Unilateral or asymmetric congenital ptosis, head posturing, and amblyopia

Purpose: To determine the prognostic implication of compensatory head postu ring in patients with unilateral or asymmetric congenital ptosis. Methods: A retrospective review of 80 consecutive patients with unilateral or asymmetric congenital ptosis was performed. The presence of documented c ompensatory head posturing, age of onset, age of presentation, visual acuit y, refraction, and amblyopia were recorded, and binocularity was tested. Results: Five of seven (71%), patients with unilateral or asymmetric congen ital ptosis and compensatory head posturing had amblyopia. All of these pat ients had straight eyes and four of the five amblyopic patients had anisome tropia of less than 2 diopters (D). Conclusion: The high incidence of amblyopia in this group can occur in the absence of significant anisometropia and strabismus. This unusually high in cidence of amblyopia in this subgroup of patients with unilateral or asymme tric congenital ptosis and compensatory head posturing warrants compulsive examination and prophylactic part-time occlusion therapy of the nonptotic e ye until reliable vision testing can be performed.